Healthcare associated infections (HAI) are common in nursing homes and are often caused by multidrug- resistant organisms (MDRO) such as MRSA and antibiotic resistant Gram-negative bacteria (R-GNB). These MDROs colonize residents and can be spread from resident to resident by healthcare personnel. The use of gowns and gloves can prevent this spread decreasing the risk of HAI; however, their use detracts from a home-like environment which is an important priority for nursing homes. The evidence for when to wear gowns and gloves in nursing homes and with which residents is lacking. In order to inform infection control practices in this setting, we recently completed an AHRQ funded project (1R18HS019979-01A1) to study MRSA transmission to gowns and gloves worn by healthcare personnel interacting with nursing home residents. Over 400 residents from 13 community-based nursing homes in Maryland and Michigan were enrolled. Cultures were obtained from each resident's anterior nares and perianal skin. We then asked healthcare personnel to wear gowns and gloves during usual care visits (e.g. bathing). A research coordinator observed and recorded the types of care delivered. At the end of each visit, the research coordinator swabbed the healthcare personnel's gown and gloves prior to disposing of them. From 401 enrolled residents, we identified 113 residents colonized with MRSA. We found high rates of MRSA contamination on both gowns (14%) and gloves (24%). Importantly there were specific types of care and specific resident characteristics with a high risk of MRSA transmission. These results suggest several novel, evidence-based approaches to the use of gowns and gloves to reduce MRSA transmission. Determining whether the transmission of R-GNB is similar or different to the transmission of MRSA is key to deciding on the best of these approaches. The aim of this application is to estimate the overall and care- activity specific transmission risk for R-GNB using this unique existing collection of specimens. We will use culture based methods to detect R-GNB from our previously collected perianal swabs. Our preliminary data suggests that R-GNB transmission is lower than MRSA. We will test the following hypotheses: Hypothesis 1: Risk of R-GNB transmission to gowns and gloves is lower than the risk of MRSA transmission to gowns and gloves. Hypothesis 2: Risk of R-GNB transmission varies by type of contact with the resident. Some activities such as those involving care at high risk for MRSA transmission (e.g. bathing) are of higher risk than those not involving care at low risk for MRSA transmission (e.g. medications). This study will extend the findings on MRSA transmission to R-GNB providing further evidence for determining the optimal use of gowns and gloves to prevent the transmission of MDROs in community-based nursing homes.